title: Successive treatment with cyclosporine and infliximab in steroid-refractory ulcerative colitis.
abstract: OBJECTIVE
  Rescue therapy with either cyclosporine (CYS) or infliximab (IFX) is an effective option in patients with intravenous steroid-refractory attacks of ulcerative colitis (UC). In patients who fail, colectomy is usually recommended, but a second-line rescue therapy with IFX or CYS is an alternative. The aims of this study were to investigate the efficacy and tolerance of IFX and CYS as a second-line rescue therapy in steroid-refractory UC or indeterminate colitis (IC) unsuccessfully treated with CYS or IFX.
  
  
  METHODS
  This was a retrospective survey of patients seen during the period 2000-2008 in the GETAID centers. Inclusion criteria included a delay of <1 month between CYS withdrawal (when used first) and IFX, or a delay of <2 months between IFX (when used first) and CYS, and a follow-up of at least 3 months after inclusion. Time-to-colectomy, clinical response, and occurrence of serious adverse events were analyzed.
  
  
  RESULTS
  A total of 86 patients (median age 34 years; 49 males; 71 UC and 15 IC) were successively treated with CYS and IFX. The median (± s.e.) follow-up time was 22.6 (7.0) months. During the study period, 49 patients failed to respond to the second-line rescue therapy and underwent a colectomy. The probability of colectomy-free survival (± s.e.) was 61.3 ± 5.3% at 3 months and 41.3 ± 5.6 % at 12 months. A case of fatal pulmonary embolism occurred at 1 day after surgery in a 45-year-old man. Also, nine infectious complications were observed during the second-line rescue therapy.
  
  
  CONCLUSIONS
  In patients with intravenous steroid-refractory UC and who fail to respond to CYS or IFX, a second-line rescue therapy may be effective in carefully selected patients, avoiding colectomy within 2 months in two-thirds of them. The risk/benefit ratio should still be considered individually.
authors.affiliation: Hôpital Saint-Louis, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Leblanc
authors.forename: M
authors.initials: M
authors.lastname: Allez
authors.forename: P
authors.initials: P
authors.lastname: Seksik
authors.forename: B
authors.initials: B
authors.lastname: Flourié
authors.forename: H
authors.initials: H
authors.lastname: Peeters
authors.forename: J L
authors.initials: JL
authors.lastname: Dupas
authors.forename: G
authors.initials: G
authors.lastname: Bouguen
authors.forename: L
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: B
authors.initials: B
authors.lastname: Duclos
authors.forename: A
authors.initials: A
authors.lastname: Bourreille
authors.forename: O
authors.initials: O
authors.lastname: Dewit
authors.forename: Y
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: P
authors.initials: P
authors.lastname: Michetti
authors.forename: S
authors.initials: S
authors.lastname: Chaussade
authors.forename: P
authors.initials: P
authors.lastname: Saussure
authors.forename: J Y
authors.initials: JY
authors.lastname: Mary
authors.forename: J F
authors.initials: JF
authors.lastname: Colombel
authors.forename: M
authors.initials: M
authors.lastname: Lémann
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000139:chemically induced; D000069285:Infliximab; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000401:mortality; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D013256:Steroids; D016572:Cyclosporine; D000069285:Infliximab